Healthcare Provider Details

I. General information

NPI: 1841450996
Provider Name (Legal Business Name): HEIDI R YOUNT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 N MAIN ST
ARCANUM OH
45304-1426
US

IV. Provider business mailing address

5735 MEEKER RD
GREENVILLE OH
45331-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-692-6601
  • Fax:
Mailing address:
  • Phone: 937-548-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35097378
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125054685
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: